Internal Medicine Commons^™

From Peg To Perfusion: A Case Of Malnutrition Reversed By Mesenteric Revascularization, Sacha Saba, Mahi Basra, Alvin Newman Caro, Vikas Sethi, Marc Kudelko

West Florida Division GME Research Day 2026

No abstract provided.

Acute Myocardial Infarction In A Patient With Concurrent Atherosclerotic Disease And Significant Myocardial Bridging, Jason Stanberry, Ankith Motkar, Daniela Salazar, Ahmed Tarbay, Kumaraswamy Nutalapati, Sabry Omar

West Florida Division GME Research Day 2026

No abstract provided.

Evaluation Of Transthoracic Echocardiography Use In Low-Risk Syncope Patients Utilizing The Canadian Syncope Risk Score: A Qi Analysis, Muhammad Anzar Ullah, Ali Hassan, Ryan Fernandez, Yousuf Qureshi, Areeb Zafar, Farhan Hiya, Huzaifa Hakim, Mohamad Saad, Trushil Patel

West Florida Division GME Research Day 2026

No abstract provided.

Cauda Equina Syndrome Secondary To Lumbar Stenosis In A Patient With Coexisting Peripheral Arterial Disease, Abboud Batri, Nawras Ibrahim, Hina Mannan

Gulf Coast Division GME Research Day 2026

No abstract provided.

Qi Project: Improving Utilization Of Cardiac Monitoring On Inpatients Based On Aha Guidelines, Muhammad Humais, Jorim Parmar, Shakir Al-Ezzi, Florence Murray, David Maldonado, Mohan Sengodan

North Texas GME Research Forum 2026

No abstract provided.

Case Of Enterococcus Faecalis Infective Endocarditis 6-Weeks Following Post-Partum Hemorrhage, Zohaib Nadeem, Mason Goforth, Yasasvi Sabbineni, Sadia Zahid, Yugandhra Devarapalli, Javed Akram, Veeranna Vibhuti

North Texas GME Research Forum 2026

Peri-partum infective endocarditis (IE) is a rare but serious condition with high maternal and fetal morbidity and mortality. IE is exceedingly uncommon in young healthy patients, especially without any known risk factors such as intravenous (IV) drug use, congenital heart disease, or rheumatic heart disease. IE is estimated to complicate 0.00002% of in-hospital deliveries. Similar to the general population, staphylococcal and streptococcal species remain the most common pathogens in obstetric patients. Enterococcal species make up less than 10% of IE cases in pregnant women. Very few cases of enterococcal IE in the post-partum period are reported in the literature. We …

Drug-Induced Acute Interstitial Nephritis Presenting As Severe Acute Kidney Injury Requiring Temporary Hemodialysis, Nihar Raju, Rohit Nair, Vaishnavi Singh, Veeranna Vibhuti

North Texas GME Research Forum 2026

Background: Acute interstitial nephritis (AIN) is an important but often underrecognized cause of acute kidney injury (AKI), accounting for 2–5% of all kidney biopsies and up to 20% of biopsies performed for AKI. Drug-induced AIN is the most common etiology in developed countries, frequently associated with antibiotics, nonsteroidal anti-inflammatory drugs, and proton pump inhibitors. Classic hypersensitivity features are frequently absent, leading to delayed diagnosis and increased risk of dialysis dependence.

Case Presentation: A 74-year-old male with a history of prostate cancer, type 2 diabetes mellitus, and hypertension presented with progressive exertional dyspnea and was found to have severe AKI without …

Acute Gastrointestinal Bleeding Associated With Cowden Syndrome: A Case Report, Gennipher A. Smith, Robert Keller

North Texas GME Research Forum 2026

No abstract provided.

Negative Imaging, Ongoing Hemorrhage: An Ulcerated Jejunal Avm Requiring Advanced Endoscopic Intervention, Joel Mathews, Trina Lewis, John Mathew, Long Hoang

North Texas GME Research Forum 2026

Small bowel bleeding is relatively uncommon, accounting for less than 10% of all gastrointestinal (GI) bleeds. Small bowel angiodysplasias are the most common cause of small bowel bleeding. These lesions can often be difficult to identify on radiographic imaging or endoscopy and tend to rebleed after intervention. Our case centers on an 86-year-old patient who presented with an acute GI bleed from an obscure ulcerated jejunal arteriovenous malformation (AVM); his past medical history includes an undisclosed prior upper GI bleed treated with endoscopic clipping, paroxysmal atrial fibrillation, type 2 diabetes, prostate cancer with prostatectomy, and other chronic conditions. He presented …

The Rapid Case Of Anoxic Brain Injury Secondary To Hyperammonemia, Jacqueline Bekhit, Ngoc Vu, Jiaming Xue, Gabriella David, Qasim Sajawal

North Texas GME Research Forum 2026

Background: Acute hyperammonemia presents as a toxic state with the clinical presentation as altered consciousness, seizures, and coma. Hyperammonemia disrupts astrocytes osmotic balance via glutamine accumulation, triggering brain edema, inflammation, and apoptosis whom mechanism is closely parallel to hypoxic ischemic injury. This overlap necessitates differentiating metabolic causes from hypoxic etiologies, as timely ammonia clearance therapies can prevent catastrophic outcomes. This case underscores the need for close clinical vigilance and early recognition of severe hyperammonemia

Case Presentation: A 65-year-old woman with metabolic dysfunction-associated steatotic liver disease related cirrhosis complicated by recurrent ascites requiring bimonthly paracentesis presented with abdominal distension and pain. …

An Unusual Source Of A Lethal Pathogen: Paeniclostridium Sordellii Bacteremia In Acute Cholecystitis, Myrna Garcia, Leena Algarin, Olutoyin Abitoye, Rachel Gnanaprakasam

North Texas GME Research Forum 2026

Paeniclostridium sordellii is a spore-forming, gram-positive, anaerobic bacilli known for its highly virulent toxin production, often leading to fulminant sepsis and shock. It is most commonly associated with gynecologic infections and necrotizing soft tissue infections associated with intravenous drug use. However, reports of P. sordellii bacteremia in the setting of gall bladder infections are quite rare. This case report highlights an unusual presentation of P. sordellii infection with bloodstream infection originating from acute cholecystitis, demonstrating a non-fulminant clinical course and successful treatment with ceftriaxone.

Ashwagandha-Associated Liver Injury: A Systematic Literature Review, David Teplitsky, Jacob Sebaugh, Danielle Ford, Rashid Syed

North Texas GME Research Forum 2026

Background: Ashwagandha (Withania somnifera), an herb with origins in Ayurvedic medicine, has recently grown in global popularity due to its reported stress- and anxiety-relieving properties. While generally regarded as safe, emerging cases in medical literature have raised concern for its ability to cause drug- or herb-induced liver injury (DILI/HILI). As use of this supplement rises, it is particularly important to characterize ashwagandha’s potential hepatotoxicity.

Methods: Cases of ashwagandha-induced liver injury were collected by accessing PubMed, Europe PMC, Google Scholar, and the HCA Healthcare Library and searching combinations of the terms “liver” or “hepatic” and one of the following names for …

Salvage Percutaneous Spyglass-Assisted Lithotripsy Via A Cholecystostomy Tract After Failed Ercp: A Case Report, Nicholas Gerden, Tiffany Hong, Asad Rehman, Long Hoang

North Texas GME Research Forum 2026

IR-driven percutaneous cholangioscopy with SpyGlass-assisted lithotripsy is an emerging salvage technique for biliary stone disease in patients with failed or contraindicated endoscopic retrograde cholangiopancreatography (ERCP) due to complex anatomy. We report an 85-year-old patient with an indwelling cholecystostomy tube and biliary stent who presented with recurrent obstructive jaundice, with cholangiography demonstrating occlusion of the common bile duct stent due to choledocholithiasis. Conventional ERCP was unsuccessful because of complex biliary and gastrointestinal anatomy. A multidisciplinary interventional radiology–gastroenterology approach was therefore pursued, utilizing antegrade percutaneous choledochoscopy through an existing cholecystostomy tract with SpyGlass-assisted lithotripsy, followed by cholecystostomy tube exchange. The procedure resulted …

Cocaine Kicks Mitral Valve In The Pap- A Rare Case Of Papillary Muscle Rupture Secondary To Cocaine-Induced Ischemia Mimicking A Tumor Vs Vegetation, Greeshma Molugu, Seline Haci, Mehdi Khalafi, Amir Z. Malik, Machaiah Madhrira

North Texas GME Research Forum 2026

Background: Cocaine is known to have many cardiotoxic effects, specifically secondary to increased sympathetic output from the increased catecholamines, calcium modulation, and increased platelet aggregation. This can cumulatively cause suppression of myocardial contractility and decreased coronary blood flow, resulting in arrhythmias, myocardial ischemia, or even infarction. Papillary muscle rupture, already a rare complication of myocardial infarction (MI), is exceedingly rarely associated with cocaine toxicity in the absence of MI. Also, acute mitral regurgitation(MR) due to papillary muscle rupture from cocaine-induced ischemia remains exceedingly rare. We present a second-ever reported case of papillary muscle rupture secondary to cocaine-induced ischemia in the …

Hemoptysis And Shock From A Proximal Bronchial Artery Aneurysm Successfully Treated With Endovascular Embolization, Gautham Raghuthaman, Charmi Mehta, Tamer Hudali

North Texas GME Research Forum 2026

Background: Bronchial artery aneurysm (BAA) is a rare vascular abnormality and an uncommon cause of hemoptysis. Although many BAAs are asymptomatic, rupture can result in life-threatening hemorrhage and shock. Proximal BAAs arising near the bronchial artery origin are particularly rare and may be underrecognized due to nonspecific clinical and radiographic findings.

Case Presentation: Patient is a 49-year-old male with a history of pituitary tumor resection complicated by secondary adrenal insufficiency and hypothyroidism presented with three days of cough, fatigue, and hemoptysis. He was hypotensive and hypoxic on arrival and required vasopressor support with stress-dose corticosteroids. Computed tomography angiography (CTA) of …

Antibody-Mediated Allograft Rejection 23 Years After Heart Transplant, Jorim Parmar, Boney Lapsiwala, Devika Adusumilli, Sienna Luk, Nguyen Dung, Song Li, Kamala Tamirisa

North Texas GME Research Forum 2026

INTRODUCTION: Orthotopic heart transplantation (OHT) remains the gold standard treatment for patients with advanced heart failure refractory to optimal medical and device-based therapies. Despite advances in perioperative management, immunosuppressive regimens, and long-term surveillance protocols, graft rejection remains a major determinant of post-transplant morbidity and mortality [1]. We report a case, representing one of the longest documented intervals in literature, of suspected antibody-mediated rejection (AMR) occurring 23 years after heart transplantation in which conventional endomyocardial biopsy (EMB) could not be successfully performed. This case highlights the diagnostic uncertainty associated with very late AMR and underscores the potential role of clinical presentation, …

An Unusual Culprit Behind A Massive Pulmonary Embolism: Atypical May-Thurner Syndrome From Iliac Artery Aneurysm, Boney Lapsiwala, Jiaming Xue, Mayank Singh, Sai Krishan Reddy Dronadula, Sadia Zahid, Mian Yousef

North Texas GME Research Forum 2026

Background: Venous thromboembolism (VTE) is a major cause of global morbidity and mortality. May-Thurner syndrome (MTS) is an iliofemoral venous compression syndrome caused by extrinsic compression of the left common iliac vein (LCIV), classically by the right common iliac artery at the level of the fifth lumbar vertebra. Although the estimated anatomic prevalence ranges from 18-49%, only 2-5% of cases are diagnosed during evaluation for lower-extremity deep vein thrombosis (DVT). Clinical manifestations range from asymptomatic venous compression to unilateral leg swelling, venous insufficiency, and acute iliofemoral DVT, with pulmonary embolism (PE) reported infrequently.

Case presentation: A 75-year-old man with hypertension, …

A Hidden Culprit: Disseminated Tuberculosis Masquerading As Abdominal Abscesses, Sudiksha Veerareddy, Alex Hall, Urvi Sakhuja, Sarah Abuelayyan, Evangelista Ezenduka, Rinu Varghese

North Texas GME Research Forum 2026

Introduction: Tuberculosis (TB) is an insidious pulmonary infection that is most prevalent in developing countries. Primary TB may also become latent after initial infection and remain dormant in the body until the patient becomes immunocompromised. The infection will then resume and can become disseminated, moving hematogenously and through the lymphatics to other areas of the body. Disseminated TB is known to manifest in a variety of ways, making it difficult to diagnose.

Case Presentation: A 28-year-old- male patient presented to Medical City Arlington with complaints of left lower quadrant abdominal pain. He immigrated from Cameroon 4 years prior. Initial CT …

A Rare Case Of Disseminated Strongyloidiasis Causing Polymicrobial Sepsis In A Patient With Lupus: A Diagnostic Conundrum, Greeshma Molugu, Anupama Chennupati, Ayo Dereje, Machaiah Madhrira

North Texas GME Research Forum 2026

Introduction: Disseminated strongyloidiasis is a very rare condition with case-fatality rates approaching 90%. However, the diagnosis is often delayed because of nonspecific presenting symptoms. Early diagnosis relies on a high index of clinical suspicion, especially in immunocompromised hosts. Long-term corticosteroid therapy, leading to some suppression of inflammatory and immunologic responses, is a well-known risk factor for severe strongyloidiasis.

Case presentation: A 52-year-old male with a past medical history of lupus on chronic corticosteroid therapy presented with chief complaints of dyspnea and diarrhea. He has a recent history of travel to Mexico. Hemoglobin was 5.3. CTAP with contrast showed diffuse colitis …

Transcatheter Aortic Valve Replacement For Moderate Aortic Stenosis In Heart Failure With Reduced Ejection Fraction: A Randomized Comparison With Guideline-Directed Medical Therapy, Yves Najm Mrad, Ahmad Al-Taweel, Bahaeddin Shabaneh

Gulf Coast Division GME Research Day 2026

No abstract provided.

Tricenarian Seizure Cascade: Uremic Encephalopathy And Suspected Dialysis Disequilibrium, Purva Dahat, Jessica Nguyen, Sara Abuelayyan, Amnah Andrabi

North Texas GME Research Forum 2026

Introduction Uremic encephalopathy and dialysis disequilibrium syndrome (DDS) are distinct neurologic complications of renal failure that can precipitate seizures. While uremic encephalopathy reflects toxin-mediated metabolic dysfunction, DDS may occur during hemodialysis initiation from rapid osmotic shifts. They are usually described as separate entities, particularly in established CKD. Sequential neurologic events spanning the pre-dialysis period and dialysis initiation in previously undiagnosed renal failure are poorly characterized.

Case presentation A previously healthy African American man in his 30s with no known history of kidney disease presented with new-onset generalized tonic-clonic seizure accompanied by respiratory distress. Initial laboratory testing revealed profound azotemia with …

Acute-On-Chronic Right Pulmonary Artery Thrombus With Systemic–Pulmonary Collateral Fistulas And Post-Thrombectomy Distal Rca Occlusion Due To Pfo, Joseph Davis, Jesse Bolton, Sridhar Sampath Kumar, Sundeep Viswanathan

Continental and Mountain Divisions GME Resarch Day 2026

No abstract provided.

A Mixed Cause Of Heart Failure, Brandon West, Austin Meyer, Kenya Lindstrom, Jason Hall, Jennifer Griffith

Continental and Mountain Divisions GME Resarch Day 2026

No abstract provided.

Navigating Recurrent Hematuria In Vesicular Varices: A Case Of Successful Multidisciplinary Intervention, Morgan Grosdidier, Muiz Khan Tareen, Danielle Ford

North Texas GME Research Forum 2026

Background Hematuria secondary to vesicular varices is a rare but serious complication of portal hypertension, often associated with liver cirrhosis. Effective management requires a multidisciplinary approach, often involving urology, gastroenterology, and interventional radiology to address acute bleeding and prevent recurrence.

Case Presentation We present a case of a patient with alcoholic liver cirrhosis who experienced severe hematuria, highlighting the diagnostic and therapeutic challenges encountered. The patient presented with a two-day history of acute hematuria and blood clots, ultimately attributed to vesicular varices secondary to portal hypertension from alcoholic liver cirrhosis. Urology was consulted, who recommended continuous bladder irrigation (CBI), initially …

Extra-Intestinal Clostridioides Difficile Abscess In A Small Bowel Gist: A Rare Tumor-Associated Complication, Nicholas Gerden, Pradip Gautam, Asad Rehman, Long Hoang

North Texas GME Research Forum 2026

Extra-intestinal infections caused by Clostridioides difficile are exceedingly rare and typically occur in settings that disrupt the gastrointestinal barrier, including recent gastrointestinal surgery, bowel perforation or microperforation, and severe colonic disease.

We present the case of a 75-year-old man with abdominal pain and hemoperitoneum in the setting of a suspected small bowel leak secondary to an intestinal mass. Computed tomography angiography revealed an 11.0 × 9.6 cm pelvic fluid collection, prompting exploratory laparotomy with drainage of a pelvic abscess and evacuation of hemoperitoneum. Intraoperatively, a small bowel perforation caused by a 4.4 cm gastrointestinal stromal tumor (GIST) was identified. Operative …

Operative Localization Of Occult Gastrointestinal Bleeding Using Intraoperative Small Bowel Endoscopy, Shuda Xia, Furrukh Jabbar, Muhammad T. Siddique

North Texas GME Research Forum 2026

No abstract provided.

Roles Of Thyroid Stimulating Hormone (Tsh) And Vitamin D Levels In Asthma Severity And Length Of Stay, Kumail Rizvi, Kenny Tran, Michele Mccarrol, Mohan Sengodan

North Texas GME Research Forum 2026

Background: Asthma exacerbations leading to hospitalization are very common and result from multifactorial causes. This research aims to investigate factors such as thyroid-stimulating hormone (TSH) and Vitamin D, which may play a role in the modulation of asthma-related hospitalizations and patient outcomes. TSH influences numerous cellular processes in the body, particularly during times of stress and illness, yet its role in asthma exacerbations and hospital length of stay remains unclear. Vitamin D has been studied for its role in enhancing medication absorption and regulating immune function, and multiple studies have shown that low serum Vitamin D levels are associated with …

Don’T Blame The Heart When On Steroids: A Rare Case Of Glucocorticoid Dependant Childhood Asthma Causing Non-Ischemic Dilated Cardiomyopathy, Greeshma Molugu, Srinivasan Rajaganapathy, Machaiah Madhrira, Karthik Anand

North Texas GME Research Forum 2026

Background: Steroids are known to have various cardiac side effects, such as hypertension, left ventricular hypertrophy, myocardial infarction, and sudden cardiac death. They are also known to cause rare but potentially life-threatening cardiomyopathy. The mechanisms behind steroid-induced cardiomyopathy are multifactorial, potentially involving direct or indirect myocardial toxicity, such as tissue fibrosis, apoptosis, and alterations in cardiac remodeling pathways via the renin-angiotensin-aldosterone system. Cardiomyopathy is known to occur with anabolic steroid use, but the literature on glucocorticoid-induced cardiomyopathy is scant. We present a rare case of glucocorticoid-induced dilated cardiomyopathy(DCM) in a patient with a history of refractory asthma who was treated …

A Rare Case Of Successful Resolution Of Bifurcation Stenosis Using Double Kissing Crush Stenting Technique, Greeshma Molugu, Tony Alacron, Karthik Anand, Machaiah Madhrira

North Texas GME Research Forum 2026

Introduction: Bifurcation lesions are associated with greater procedural complexity and consequently are at higher risk for stent restenosis. Bifurcation lesions are still technically challenging even in the era of modern stents. High incidence of restenosis both in the main vesseI and side branch Iimits the Iong-term prognosis. We present a rare case of successful resolution of bifurcation stenosis in a patient by using the double kissing (DK) crush stenting technique.

Case Description: A 52-year-old male patient with a past medical history of hypertension presented to the hospital for elective left heart catheterization as a part of an evaluation for a …

Fournier Gangrene Incidentally Found And Caused By Actinomyces Odontolyticus, A Rare Finding, Munanchu Poudel, Manzoor Bevinal, Brandi Addison

Gulf Coast Division GME Research Day 2026

No abstract provided.